- Email: [email protected]
Comparison of sonographic findings in the scrotum of mountain bikers and on-road cyclists
362
361 COMPARISON OF SONOGRAPHIC FINDINGS IN THE SCROTUM MOUNTAIN BIKERS AND ON-ROAD CYCLISTS Frauscher
Ferdinand’,
‘Radiology. Austria
Radiology
Klauser
Andrea’.
II, Innsbruck,
Stenzl Amulf-, Austria,
MRI DIAGNOSIS
OF
Dobrowolski
Bartsch Georg2
‘Urology.
Urology,
‘Urology,
Innsbruck,
MATERIALS & METHODS: We studied 85 male mountain bikers (mean age: 25 years, range 17-45 years) and 50 on-road cyclists (mean age: 23 years, range IS-46 years) with regard to scrotal findings on ultrasound (US). Only males who gave a history of extensive mountain biking or on-road bicycling (2 hours or more per day on 6 days a week; covered distance of more than 5000 km/year) were entered in our study. In addition to clinical evaluation, a standard ultrasonographic examination of the scrotum was performed using a linear array transducer operating at a frequency of 8.0 MHz (Acuson Sequoia 512). The aonographic findings obtained in the mountain bikers were compared with those obtained in the on-road cyclists.
Collegium
INTRODUCTION
statistically
significant
MATERIALS
363 THE VALUE OF COLOUR-CODED Altinkilic Department
possibilities
Krak6w,
of the bladder
The group
was presentation
cancer
of 29 patients
with primarily
bladder tumour in USC and filling defect in cystography)
bladder tumour was included to the study. In each case MRI (SIGNA I .ST-GEMS) workstation.
of the pelvis Images
were performed.
TI and T2, axial,
Image
coronal,
patient
underwent
TURBT
of the bladder
conventional
3D and virtual
cystoscopy
cystoscopy
Comparison
cystoscopy
in spinal
confirmed
no muscular
were compared
images
regarding
of the tumour. In 20 patient with pathologically cancer MRI diagnosis
anesthesia
and by with
specimens.
cystoscopy
100% correlation
were
Then each
were assessed independently
and pathological
of virtual
images confirmed
cystoscopy
by a radiologist.
The MRI images with virtual cystoscopy
results of traditional RESULTS:
rigid
The specimens
tumour.
HORIZIN
data were sent to the image
The images were assessed independently
obtained.
Poland,
Krakbw, Poland
The aim of the study
in assessment
& METHODS:
(hematuria,
University,
and conventional
size and grow pattern
confirmed
superficial
bladder
bladder wall involvement
and in
two patients the results was unclear. In a group of 9 patients with pathologically muscular
invasive
bladder
tumour
the diagnosis
was confirmed
by MRI
diagnosis.
(p
CONCLUSION: US has shown a significantly higher prevalence of extratesticular as well as testicular disorders in mountain bikers compared with on-road cyclists.
DIAGNOSTIC
- OWN EXPERIEINCE
University,
MedicumJagiellonian
& OBJECTIVES:
of MRI diagnostic
two pathologists. RESULTS: Eighty of 85 mountain bikers (94%) and 24 of 50 on-road cyclists (48%) had abnormal findings on scrotal US. Abnormal US findings in mountain bikers included scrotoliths in 69 (8 I %), spermatoceles in 39 (46%). epididymal calcifications in 34 (40%). testicular calcifications in 27 (32%). hydroceles in 24 (28%). varicoceles in 9 bikers (I 1%) and testicular microlithiasis in one biker (I .5%). On-road cyclists showed scrotoliths in 8 (16’%), spermatoceles in I3 (26%). epididymal calcifications in 6 (12%). hydroceles in I4 (28%) and varicocelca in IO cyclists (20%). Thirty-nine of the mountain 85 bikers (46%) and I I of the 50 on-road cyclists (22%) had a history of intermittent xrotal tenderness or discomfort but no severe scrotal trauma. The overall number of in mountains bikers compared to on-road cyclists was scrotal abnormalities
MedicumJagiellonian
Collegium
diagnosed
CANCER
Z.‘, Urbanik A.‘, Drewniak T.l, Weglarz W.‘, Popiela T.2
‘Radiology.
INTRODUCTION & OBJECTIVES: To investigate sonographically. whether mountain bikers have a higher prevalence of scrotal abnormalities compared to on-road cyclists.
OF THE BLADDER
EVALUATION
Bora, Noeske Hans-Dieter, of Urology, University
DUPLEX
OF ACUTE
SONOGRAPHY
IN THE
Krings Thomas, Miller Joerg. Weidner Wolfgang of Giessen. Giehaen, Germany
MATERIALS & METHODS: We reviewed the outcome of the standardised diagnostic evaluation in 88 cases (mean age I6.S years) with an acute scrotum. Colour%oded duplex sonograohv (Kretr, 7.5 MHz) was nerformed in all cases. Subseuuentlv. the . diignoais v& e;aiuated by explorative surg&y. RESULTS: The followine table comoares the results of CCDS with intraoDerative findings: Intraoperative diagnosis Preoperative duplex: - Preoperative duplex: + Testicular torsion 0 4s Trauma with testicular rupture I 0 Hydatid torsion 2 28 Y Enididvmitis 2 * *
1I
10
method,
010
MRI
is very
I
In 51 panents with negative testicular perfusion, testicular torsion was the underlying disease in 45 cases and trauma with rupture in one case. However, in the remaming S cases (2 hydatid torsions. 2 epididymitis and I patient after manual detorsion) a decreased testicular perfusion as seen with prior CCDS could not be confirmed by explorative surgery. 28 patients with hydatid torsion and 9 patients with epididymitia intraoperatively had normal blood flow detected by CCDS. These patienta underwent surgery because of severe scrotal symptoms. CONCLUSION: CCDS appears to he a useful tool in the preoperative evaluation of acute scrotum. It correctly predicted the need for an operation in 46 of 5 I patients (90%,) in case of misTine testicular nerfusion and correctlv oredicted the outcome in all 37 patients with no&al blood f&v preoperatively. In c& with the presence of testicular perfusion, conservative management can he an effective means of treatment if the course of the hydatid torsion or epididymitis is reasonably mild and painless. However, a surgical exploration is recommended in all patients with lack of testicular perfusion intended to never miss a teatlcular torsion
useful
bladder tumour allowing which
allow
obtaining
in non-invasive
precise staging.
images
comparable
diagnosis
MRI
of superficial
VC is a non-invasive
with traditional
cystoscopy.
TESTIS CAWER Monday, February25,13.45-l 5.15 hrs, Room C
COST-EFFECTIVENESS TESTICULAR CANCER
SCROTUM
INTRODUCTION & OBJECTIVES: The differential diagnosis of acute scrotum is challenging. It is important to make an accurate diagnosis to provide immediate and appropriate therapy. especially in case of torsion of the spermatic cord. However. clinical history is often of limited value and scrotal pain can make the physical examination difficult. In case of testicular torsion surgical therapy is mandatory while in case of hydatid torsion or epididymitis conservative management is justified. We analysed the usefulness of colour-coded duplex aonography (CCDS) to improve diagnostic in such cases.
Successful manual detorsion
CONCLUSION: egzofitic
ANALYSIS PATIENTS
Spermon
Roan, Witjes Fred. DeBruijne
Urology,
UMC Nijmegen.
INTRODUCTION & followup for patients unclear. The aim of this programmed follow-up
Nijmegen,
OF
Frans. Kiemeney
364 FOLLOW-UP
IN
Bart
The Netherlands
OBJECTIVES: Guidelines on the type and frequency of in complete remission for testicular germ cell tumour are retrospective study was to evaluate the cost-effectiveness of in the detection of recurrence of testicular cancer.
MATERIALS & METHODS: The charts of all patients, treated between 1982 and 2000, were reviewed. Patients were considered eligible for analysis if they were both in complete remission for at least three months after first-line treatment and routinely followed-up. Follow-up included physical examination, CT-scan, x-ray of thorax and serum tumour markers. Programmed follow-up was stopped in case of relapse, death or on patient’s demand. For each patient, the cost of follow-up was the total costs for each procedure multiplied by its frequency. Effectiveness of follow-up was defined as the number of patients with asymptomatic tumour recurrence, solely detected by the follow-up program and were curatively treated for recurrence, divided by all patients in the follow-up program. RESULTS: Among SOS eligible patients (360 nonseminoma), 42 patients experienced a relapse. Thirty-six patients relapsed asymptomatically (6 contralateral, 30 distant) as detected by median follow-up of 6 months (range: 4-71). Finally, 27 relapses were treated curatively, resulting in effectiveness of follow-up of 5.3% (271505). For 505 patients. I million euros were spent for programmed follow-up.The follow-up costs for 27 cured recurrence patients were 25.000 euros, resulting in a cost-effectiveness ratio of 40: 1.At 1, 3 and 5 year. the disease free survival rate was 9X&,93%. and 928 respectively. The l-year disease free survival rate from the date of first recurrence was 91% in asymptomatic and 80% in symptomatic patients (p>o.OS). Remarkably. in low stage non-seminomatous disease (n=223), pulmonary recurrences (all asymptomatic) were seen only m patients who were on surveillance only (3124) or in patients who were negatively staged by surgery (10193). In contrast, 106 patients who were adjuvantly treated with chemotherapy for proven lymph node metastases did not relapse at all. Four low staged patients experienced a contralateral relapse by self-exam after completion of follow-up at a median of I20 months (range 100-140). CONCLUSION: Prospective studies are recommended to optimise the follow-up protocol regarding effectiveness and financial cost, especially in low stage disease. Life-long self-examination should be advocated.
European Urology Supplements
1 (2002) No. 1, pp. 93
361 COMPARISON OF SONOGRAPHIC FINDINGS IN THE SCROTUM MOUNTAIN BIKERS AND ON-ROAD CYCLISTS Frauscher
Ferdinand’,
‘Radiology. Austria
Radiology
Klauser
Andrea’.
II, Innsbruck,
Stenzl Amulf-, Austria,
MRI DIAGNOSIS
OF
Dobrowolski
Bartsch Georg2
‘Urology.
Urology,
‘Urology,
Innsbruck,
MATERIALS & METHODS: We studied 85 male mountain bikers (mean age: 25 years, range 17-45 years) and 50 on-road cyclists (mean age: 23 years, range IS-46 years) with regard to scrotal findings on ultrasound (US). Only males who gave a history of extensive mountain biking or on-road bicycling (2 hours or more per day on 6 days a week; covered distance of more than 5000 km/year) were entered in our study. In addition to clinical evaluation, a standard ultrasonographic examination of the scrotum was performed using a linear array transducer operating at a frequency of 8.0 MHz (Acuson Sequoia 512). The aonographic findings obtained in the mountain bikers were compared with those obtained in the on-road cyclists.
Collegium
INTRODUCTION
statistically
significant
MATERIALS
363 THE VALUE OF COLOUR-CODED Altinkilic Department
possibilities
Krak6w,
of the bladder
The group
was presentation
cancer
of 29 patients
with primarily
bladder tumour in USC and filling defect in cystography)
bladder tumour was included to the study. In each case MRI (SIGNA I .ST-GEMS) workstation.
of the pelvis Images
were performed.
TI and T2, axial,
Image
coronal,
patient
underwent
TURBT
of the bladder
conventional
3D and virtual
cystoscopy
cystoscopy
Comparison
cystoscopy
in spinal
confirmed
no muscular
were compared
images
regarding
of the tumour. In 20 patient with pathologically cancer MRI diagnosis
anesthesia
and by with
specimens.
cystoscopy
100% correlation
were
Then each
were assessed independently
and pathological
of virtual
images confirmed
cystoscopy
by a radiologist.
The MRI images with virtual cystoscopy
results of traditional RESULTS:
rigid
The specimens
tumour.
HORIZIN
data were sent to the image
The images were assessed independently
obtained.
Poland,
Krakbw, Poland
The aim of the study
in assessment
& METHODS:
(hematuria,
University,
and conventional
size and grow pattern
confirmed
superficial
bladder
bladder wall involvement
and in
two patients the results was unclear. In a group of 9 patients with pathologically muscular
invasive
bladder
tumour
the diagnosis
was confirmed
by MRI
diagnosis.
(p
CONCLUSION: US has shown a significantly higher prevalence of extratesticular as well as testicular disorders in mountain bikers compared with on-road cyclists.
DIAGNOSTIC
- OWN EXPERIEINCE
University,
MedicumJagiellonian
& OBJECTIVES:
of MRI diagnostic
two pathologists. RESULTS: Eighty of 85 mountain bikers (94%) and 24 of 50 on-road cyclists (48%) had abnormal findings on scrotal US. Abnormal US findings in mountain bikers included scrotoliths in 69 (8 I %), spermatoceles in 39 (46%). epididymal calcifications in 34 (40%). testicular calcifications in 27 (32%). hydroceles in 24 (28%). varicoceles in 9 bikers (I 1%) and testicular microlithiasis in one biker (I .5%). On-road cyclists showed scrotoliths in 8 (16’%), spermatoceles in I3 (26%). epididymal calcifications in 6 (12%). hydroceles in I4 (28%) and varicocelca in IO cyclists (20%). Thirty-nine of the mountain 85 bikers (46%) and I I of the 50 on-road cyclists (22%) had a history of intermittent xrotal tenderness or discomfort but no severe scrotal trauma. The overall number of in mountains bikers compared to on-road cyclists was scrotal abnormalities
MedicumJagiellonian
Collegium
diagnosed
CANCER
Z.‘, Urbanik A.‘, Drewniak T.l, Weglarz W.‘, Popiela T.2
‘Radiology.
INTRODUCTION & OBJECTIVES: To investigate sonographically. whether mountain bikers have a higher prevalence of scrotal abnormalities compared to on-road cyclists.
OF THE BLADDER
EVALUATION
Bora, Noeske Hans-Dieter, of Urology, University
DUPLEX
OF ACUTE
SONOGRAPHY
IN THE
Krings Thomas, Miller Joerg. Weidner Wolfgang of Giessen. Giehaen, Germany
MATERIALS & METHODS: We reviewed the outcome of the standardised diagnostic evaluation in 88 cases (mean age I6.S years) with an acute scrotum. Colour%oded duplex sonograohv (Kretr, 7.5 MHz) was nerformed in all cases. Subseuuentlv. the . diignoais v& e;aiuated by explorative surg&y. RESULTS: The followine table comoares the results of CCDS with intraoDerative findings: Intraoperative diagnosis Preoperative duplex: - Preoperative duplex: + Testicular torsion 0 4s Trauma with testicular rupture I 0 Hydatid torsion 2 28 Y Enididvmitis 2 * *
1I
10
method,
010
MRI
is very
I
In 51 panents with negative testicular perfusion, testicular torsion was the underlying disease in 45 cases and trauma with rupture in one case. However, in the remaming S cases (2 hydatid torsions. 2 epididymitis and I patient after manual detorsion) a decreased testicular perfusion as seen with prior CCDS could not be confirmed by explorative surgery. 28 patients with hydatid torsion and 9 patients with epididymitia intraoperatively had normal blood flow detected by CCDS. These patienta underwent surgery because of severe scrotal symptoms. CONCLUSION: CCDS appears to he a useful tool in the preoperative evaluation of acute scrotum. It correctly predicted the need for an operation in 46 of 5 I patients (90%,) in case of misTine testicular nerfusion and correctlv oredicted the outcome in all 37 patients with no&al blood f&v preoperatively. In c& with the presence of testicular perfusion, conservative management can he an effective means of treatment if the course of the hydatid torsion or epididymitis is reasonably mild and painless. However, a surgical exploration is recommended in all patients with lack of testicular perfusion intended to never miss a teatlcular torsion
useful
bladder tumour allowing which
allow
obtaining
in non-invasive
precise staging.
images
comparable
diagnosis
MRI
of superficial
VC is a non-invasive
with traditional
cystoscopy.
TESTIS CAWER Monday, February25,13.45-l 5.15 hrs, Room C
COST-EFFECTIVENESS TESTICULAR CANCER
SCROTUM
INTRODUCTION & OBJECTIVES: The differential diagnosis of acute scrotum is challenging. It is important to make an accurate diagnosis to provide immediate and appropriate therapy. especially in case of torsion of the spermatic cord. However. clinical history is often of limited value and scrotal pain can make the physical examination difficult. In case of testicular torsion surgical therapy is mandatory while in case of hydatid torsion or epididymitis conservative management is justified. We analysed the usefulness of colour-coded duplex aonography (CCDS) to improve diagnostic in such cases.
Successful manual detorsion
CONCLUSION: egzofitic
ANALYSIS PATIENTS
Spermon
Roan, Witjes Fred. DeBruijne
Urology,
UMC Nijmegen.
INTRODUCTION & followup for patients unclear. The aim of this programmed follow-up
Nijmegen,
OF
Frans. Kiemeney
364 FOLLOW-UP
IN
Bart
The Netherlands
OBJECTIVES: Guidelines on the type and frequency of in complete remission for testicular germ cell tumour are retrospective study was to evaluate the cost-effectiveness of in the detection of recurrence of testicular cancer.
MATERIALS & METHODS: The charts of all patients, treated between 1982 and 2000, were reviewed. Patients were considered eligible for analysis if they were both in complete remission for at least three months after first-line treatment and routinely followed-up. Follow-up included physical examination, CT-scan, x-ray of thorax and serum tumour markers. Programmed follow-up was stopped in case of relapse, death or on patient’s demand. For each patient, the cost of follow-up was the total costs for each procedure multiplied by its frequency. Effectiveness of follow-up was defined as the number of patients with asymptomatic tumour recurrence, solely detected by the follow-up program and were curatively treated for recurrence, divided by all patients in the follow-up program. RESULTS: Among SOS eligible patients (360 nonseminoma), 42 patients experienced a relapse. Thirty-six patients relapsed asymptomatically (6 contralateral, 30 distant) as detected by median follow-up of 6 months (range: 4-71). Finally, 27 relapses were treated curatively, resulting in effectiveness of follow-up of 5.3% (271505). For 505 patients. I million euros were spent for programmed follow-up.The follow-up costs for 27 cured recurrence patients were 25.000 euros, resulting in a cost-effectiveness ratio of 40: 1.At 1, 3 and 5 year. the disease free survival rate was 9X&,93%. and 928 respectively. The l-year disease free survival rate from the date of first recurrence was 91% in asymptomatic and 80% in symptomatic patients (p>o.OS). Remarkably. in low stage non-seminomatous disease (n=223), pulmonary recurrences (all asymptomatic) were seen only m patients who were on surveillance only (3124) or in patients who were negatively staged by surgery (10193). In contrast, 106 patients who were adjuvantly treated with chemotherapy for proven lymph node metastases did not relapse at all. Four low staged patients experienced a contralateral relapse by self-exam after completion of follow-up at a median of I20 months (range 100-140). CONCLUSION: Prospective studies are recommended to optimise the follow-up protocol regarding effectiveness and financial cost, especially in low stage disease. Life-long self-examination should be advocated.
European Urology Supplements
1 (2002) No. 1, pp. 93